SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Damage to the lacrimal drainage apparatus is probably a frequent occurrence during rhinoplasty and this may lead to a permanent occlusion of the drainage system with tearing. This fact is not well documented in the plastic surgery or ophthalmic literature. Four cases of epiphora following rhinoplasty are presented. The possible mechanism of the obstruction and the treatment are discussed.
From an anatomical standpoint, the nasal septum makes up the greater part of the bridge, contributes to determination of the length of the pyramid, plays a part in the formation of the columella, projects the tip and divides the space located behind the piriform orifice to limit the two nasal fossae. Deformities may thus affect the morphology of the pyramid and nasal physiology, in other words require correction for aesthetic or functional reasons. These two aspects of the question are considered in succession, with the understanding that the two problems often exist in association, in particular after trauma. Surgical action involving the septum is almost always associated with the operative protocol of a rhinoplasty for aesthetic purposes. Emphasis has been placed above all on operations for functional purposes. Three techniques are discussed: resection and reposition, considered to be procedures involving the septum only, and rhinoplasty where the operation involves the whole of the pyramid. There is no basis for the automatic rejection of any of them, but on the contrary all are valid and mutually interrelated by multiple forms of passage and association.
Open rhinoplasty is a technique that allows a sharper evaluation of nasal deformities since a visual diagnosis may be done. We present a review of the cases in which an open rhinoplasty was performed in our department in the last five years. Preoperative and postoperative data are recorded in a standardized form in order to facilitate their analysis. The techniques used for each type of nasal deformity (dorsal and basal) are described and the results discussed.
The nasal tip blood supply was studied through anatomic dissections and microangiography in 31 fresh cadaver specimens. The lateral nasal artery was present in all specimens, bilaterally in 30 (97 percent) and unilaterally in one (3 percent) and was located in the subdermal plexus 2 to 3 mm superior to the alar groove. The columellar branch of the superior labial artery was visualized bilaterally in 3 specimens (9 percent) and unilaterally in 21 (68 percent), and was absent in 7 (23 percent). Transcolumellar (external rhinoplasty) incisions were performed in 11 of these cadavers prior to dye injection. A consistent crossover flow (100 percent) was seen from the lateral nasal artery arcades to the distal aspect of the transected columellar branches. We conclude that nasal tip blood supply is derived primarily from the lateral nasal arteries, with a variable contribution from the columellar arteries. Collateral flow to the nasal tip may be provided by branches of the ophthalmic artery. The external rhinoplasty transcolumellar incision does not compromise nasal tip blood supply unless extensive tip defatting or extended alar base resections (above the alar groove) are performed.
The goal of rhinoplasty should not be necessarily a small nose but a nose which is well balanced with the face and fits with the individual. Increasing number of patients is linked with improvement of the techniques and it is frequent to see patients asking for correction of minor defects. Sequelae of rhinoplasty are still frequent but less severe, and even if their correction is difficult, it is possible in most cases, thanks to the use of cartilage grafts and external approach.
Between 1989 and 1992, eighty-one rhinoplasties included the addition of free autologous cartilage grafts, sixty-seven of which were secondary procedures. The aesthetic and respiratory results were assessed with at least one year of follow-up post-op for fifty four cases representing the true material of the study. This paper illustrates the advantages of septal cartilage graft versus conchal grafts, particularly for restitution of the dorsum of the nose. No "open rhinoplasty" procedure was necessary in this series. The authors conclude that "Sheen's" procedure using multiple isolated pockets in such cases is reliable if its basic rules are strictly applied and if one accepts that septal cartilage grafts must be preferred as far as possible.
The majority of rhinoplasty studies emphasize the management of the cartilaginous and bony nasal framework. Often overlooked is the soft tissue envelope. One hundred consecutive rhinoplasty patients were studied with respect to their soft tissue deformities, the surgical techniques applied for correction, and the aesthetic outcome. Results were analyzed utilizing preoperative and postoperative assessment sheets, progress notes, and photographs. The importance of proper diagnosis and management of soft tissue deformities in achieving superior aesthetic results is discussed. As well, clinical examples of illustrative deformities and their corrections are presented.
Description by the authors of their experience on external rhinoplasty in 250 cases, the advantage of this technique, compared to the classical extramucosa rhinoplasty and its main indications.
This paper compares two different techniques of external rhinoplasty, in which the lower lateral cartilages are either elevated with the columellar skin (i.e., Gillies-Meyer approach) or left attached to the main body of the nose (i.e., Rethi-Sercer approach). Both techniques give good access and exposure, but we found the Gillies-Meyer approach somewhat easier to perform. It can also be used to provide extended access if difficulty is experienced during a closed rhinoplasty operation.
Nasal dorsal cyst formation after rhinoplasty is considered a rare complication. These cysts are due to entrapment of mucosal remnants in the subcutaneous space. Meticulous surgical technique aimed at preserving the mucosal lining may prevent cyst formation. Surgical excision with the open approach is a reliable treatment. A case of nasal dorsal cyst after previous rhinoplasty is presented. After four years no sign of recurrence is noted.
A notch commonly appears at the midpoint of the nasal dorsum when the bridge has been resected beyond the ability of the soft tissues to contract. This notch, commonly seen in secondary rhinoplasty patients, occurs at the cephalic end of the supratip convexity and appears whether or not the tip has been overresected. The notch corresponds to the center of the "inverted V" deformity that signals middle vault collapse and may occur even when the middle vault has been reconstructed by spreader grafts. The middorsal notch also appears intraoperatively and therefore can guide the surgeon in determining the limits of dorsal skeletal resection. Ablation of the mid-dorsal notch by dorsal grafting is effective in both primary and secondary rhinoplasty patients.
Open rhinoplasty is a surgical approach to the nose. This article will review the history of the open rhinoplasty technique, comment on its advantages and disadvantages, illustrate the surgical technique and review modifications and developments that have arisen. Although of primary concern to nasal surgeons, the open approach will be of interest to all surgeons, regardless of their area of focus.
A method for determining the aesthetically proportioned nasal length, tip projection, and radix projection in any given face is described. The proportioned nasal length is two-thirds (0.67) the midfacial height and exactly equal to chin vertical. Tip projection is two-thirds (0.67) the surgically planned or ideal nasal length. Radix projection, measured from the junction of the nasal bones with the orbit, is one-third (0.33) the ideal nasal length. The preferred clinical reference for measuring radix projection is the plane of the corneal surface; the radix projects 0.28 times the ideal nasal length from this surface (range: 9-14 mm). These-dimensional relationships were confirmed from direct clinical measurements taken from 87 models and subsequently applied in 126 consecutive rhinoplasties. The significance of this dimensional approach to rhinoplasty lies in the fact that planned nasal dimensions are based on facial measurements that allow the nose to vary in size directly with the face. Furthermore, it removes the dorsum as the primary focus in dimensional assessment. Rather, the dorsal prominence may be consistently described relative to a plane connecting the "ideal" radix and tip.
The scaphal cartilaginous area is a most suitable anatomic site for cartilaginous graft harvesting. These grafts allow reconstruction of a flat dorsum, or a rounded dome, or alar cartilages or can be used for an extended tip graft. In some cases, both scaphes may be harvested. Raising of the grafts does not leave any sequelae when performed correctly. We have an experience of 20 cases. The main advantage of this graft is its flatness, which makes it ideal for the nasal dorsum. It has to be tailored, moderately crushed and included in a collagen "surgicel" in order to break the shape memory, slightly curved at its borders. We have used scaphal autografts in 15 cases of secondary rhinoplasties, 2 cases of cleft lip repair and in 3 cases of tertiary rhinoplasties. They solved most problems of missing cartilage, when minor defects had to be treated. These grafts will not solve major tissue defects which must be repaired by bone autografts, mostly iliac bone harvesting in our experience. The results of scaphal autografts are stable after 5 years. Resorption is moderate when the graft is correctly inserted, in an extramucosal pocket. The aesthetic result is maintained with a mean follow up of 2 years for 15 cases. The scaphal area of the ear therefore appears to be a favorable donor site for secondary, nose repair; it is easy to harvest, with inconspicuous morbidity and allows the raising of a good, flat and sculpturable material for cartilaginous nose replacement. Achieves the objectives of ore informed patients asking for artistic perfection.
Few other forms of surgery embody the authentic, full essence of surgery as does rhinoplasty, where functional results are joined to meet one's innermost expectations. the present work reviews the main stages in the course of the evolution of the philosophy and surgical techniques adopted to resolve both the functional and esthetic problems of the nose. This provides a broad view of the issues every surgeon has had to deal with in this regard. The history of rhinoplasty once more teaches us that the evolution of a discipline hinges around the daily renewal of one's preparation through study, observation and insights.
In staging and performing secondary iatrogenous or post-traumatic rhinoplasty, it has clearly been shown that the use of grafts plays a key role in reconstructing the defective or missing anatomical parts. On the other hand, in primary rhinoplasty, in general the one prevailing concept is removal of the osteo-cartilage to shape the nose. However, in order to achieve a good balance between aesthetics of the various parts of the nasal pyramid and their coherence with the face as a whole, it is often necessary to add at one or more points so that you can remove less elsewhere. In effect, a naturally short nasal tip, unless suitably increased, would require marked removal of the gibbus which could, in turn, throw the nasal pyramid out of proportion with the rest of the face. On the other hand, if the back of the nose is naturally too short, it creates the optical illusion of a tip which is longer than it really is. This also holds true for a tight nose-lip angle or when the portion of the face anterior to the upper jaw is set back, creating the optical illusion of a downward or elongated tip. Integrating the back of the nose, the anterior nasal spine or the canine fossae with a graft makes it possible to achieve more natural results in harmony with the rest of the face. The material of choice for the grafts used by the authors is the quadrangular cartilage of the nasal septum, both autologous and homologous. This material is preserved in a aqueous solution of 10% mertiolate. An alternative can be provided by the cartilage of the auricular concha.
The external rhinoplasty approach was used in nine patients for closure of septal perforations varying from 8 to 30 mm in diameter. Nasal obstruction was the most prominent symptom. An autologous graft was always inserted between the mucoperichondrial flaps. Seven perforations were closed successfully. Symptomatic improvement was achieved in all patients. The closure of nasal septal perforations via external rhinoplasty approach has a high percentage of success due to excellent exposure of the septum.
Exact knowledge about the magnitude of the factors influencing nasal tip projection (NTP) as a result of surgery are scarce. This study focuses on NTP changes after primary rhinoplasty using open transcolumellar approach in combination with a columellar strut, while specifically addressing four different nasal tip surgery techniques. Measurements were taken from standardised pre- and post-operative profile photographs of 73 patients with a minimal follow-up of one year. No statistically significant differences in pre- and post-operative NTP could be noted for the total group of patients. Only the group of patients in whom a nasal tip graft was applied a mean increase in NTP could be measured. A comparison of selected data from our study to data of previous studies on NTP changes after endonasal rhinoplasty demonstrates the effectiveness of the columellar strut for maintenance of NTP. Overall, our findings testify to the versatility of cartilage-structuring techniques including columellar struts and tip grafts for NTP maintenance or increase. The quantitative effect of the open approach itself on NTP remains elusive and needs further study.